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Shoulder - PowerPoint PPT Presentation


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Shoulder. Anatomy Review. 2 bones Scapula Humerus 4 joints Gleno-humeral Acromio-clavicular Sterno-clavicular Scapulo-thoracic. Rotator Cuff Muscles S I T S. Scapular Muscles Move Scapula / Greater ROM Fixate Scapula on thorax Rhomboid Major / Minor Levator Scapula

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anatomy review
Anatomy Review
  • 2 bones
    • Scapula
    • Humerus
  • 4 joints
    • Gleno-humeral
    • Acromio-clavicular
    • Sterno-clavicular
    • Scapulo-thoracic
slide4
Scapular Muscles
    • Move Scapula / Greater ROM
    • Fixate Scapula on thorax
    • Rhomboid Major / Minor
    • Levator Scapula
    • Serratus Anterior
    • Pectoralis Minor
    • Trapezius
    • Latissimus Dorsi
    • Pectoralis Major
mechanics of activities
Mechanics of Activities
  • Baseball throw
    • Windup – Cocking – Acceleration – Follow-through
  • Tennis Serve
    • Windup – Cocking – Acceleration – Follow-through
  • Tennis Backhand / Forehand
    • Racket prep – Acceleration – Follow-through
  • Swimming (Freestyle)
    • Early pull-through – Late pull-through – Early recovery – Late recovery
  • Golf Swing
    • Take-away – Forward swing – Acceleration – Follow-through
stability
Stability
  • Passive stabilizers
    • Joint capsule, ligaments, labrum
  • Active stabilizers
    • Muscles
  • Damage (Microtrauma / Macrotrauma) to passive stabilizers and weakness / dysfunction of active stabilizers  Functional Instability
other factors to consider
Other Factors to Consider
  • Posture
  • Cervical Dysfunction
  • Thoracic Dysfunction
  • Scapular Plane (Scaption)
  • Exercise Progression
    • Stay below 90° until good strength in rotator cuff
range of motion
Range of Motion
  • Pendulum Exercises (Codman’s)
  • Wand Exercises
    • Supine
    • Standing
  • Pulley Exercises
  • PROM
flexibility
Flexibility
  • Capsular stretches
    • Inferior (shoulder flexion)
    • Anterior (horizontal ext / ext rotation)
    • Posterior (horizontal flex / int rotation)
slide12
Active stretches
    • Internal Rotation
    • Rhomboid
    • Supraspinatus
slide13
Assistive
    • Supraspinatus
    • Infraspinatus
    • Subscapularis
    • Teres Minor
    • Teres Major
    • Latissimus Dorsi
slide15
Isometrics
  • Rotator Cuff Isotonics
    • MRE
    • PRE
    • Rubber bands
  • Scapular Stabilizers
    • Open Chain
    • Closed Chain
slide16
Machines
    • Deltoid
    • Pectoralis Major
    • Latissimus Dorsi
    • Rhomboids
    • Trapezius
  • Isokinetics
    • Flexion / Extension
    • Internal / External Rotation
slide18
Swiss Ball Stabilization
  • Distal Segment Stabilization
  • Rhythmic Stabilization
  • PNF Patterns (D1 / D2)
    • MRE
    • Rubber Tubing
shoulder instability
Shoulder Instability
  • TUBS
    • Traumatic, Unilateral, Bankart, Surgery
  • AMBRI
    • Atraumatic, Multi-directional, Bilateral, Rehabilitation, Inferior capsular shift
shoulder impingement
Shoulder Impingement
  • Narrowing of subacromial space
  • Primary
    • Caused by structures within the SA space (RC tendons, biceps tendon, bursa)
  • Secondary
    • Caused by shoulder dysfunction due to instability
      • Capsular laxity / tightness
      • Postural deformity
      • Rotator cuff weakness
      • Muscular imbalance
slide22
Treatment options
    • Pain / Inflammation Control
    • Secondary – Find the cause!!
      • Tight capsule – Joint Mobs
      • Loose capsule – Strengthen active stabilizers
    • Avoid aggravating activities
    • Gradual return to full activity
traumatic rc conditions
Traumatic RC Conditions
  • Acute strain
  • Partial thickness tear vs. full thickness tear
  • Post-surgical cases
  • Conservative vs. Surgical Options
arthroscopic decompression
Arthroscopic Decompression
  • Surgical procedure to clean out the subacromial space
  • Decompression
    • Primary impingement
    • May involve acromioplasty
  • Debridement
    • Chronic tendinitis / synovitis
glenoid labral tears
Glenoid Labral Tears
  • Most common in high-velocity overhead activities
  • SLAP (Superior Labrum Anterior and Posterior)
    • Usually involves LH of Biceps
  • Conservative vs. Surgical options
    • Bankart repair
    • Capsulolabral reconstruction
adhesive capsulitis
Adhesive Capsulitis
  • “Frozen Shoulder”
    • Capsular pattern of restriction at GH jt.
  • Most common in older adults
    • Female > male
  • Stage I
    • Shoulder pain, pain at EROM, sleeping difficulties, diminishing ROM (3-6 weeks of rehab)
  • Stage II
    • Very stiff shoulder, pain through available motion, elbow pain, unable to lay on affected shoulder (1-3 months of rehab)
  • Stage III
    • Pain at rest, hard-leathery end feel at EROM w/ capsular pattern, loss of scapulo-humeral rhythm (3-6 months of rehab)
  • No rehab  18 – 24 months to resolve
ac sprains
AC Sprains
  • Almost always treated conservatively
  • Grade I
    • No deformity, sling (1-2 days)
  • Grade II
    • AC ligament torn, mild deformity, sling (5-7 days)
  • Grade III
    • AC / CC ligaments torn, deformity, sling (7-14 days)
  • Type IV, V, VI – usually require surgery and involve severe damage to AC and surrounding tissues.
biceps tendon injuries
Biceps Tendon Injuries
  • Bicipital tendinitis
    • Usually secondary to instability, impingement, RC pathology
  • Biceps tendon ruptures
    • More common in middle-aged adults especially with RC pathology
    • Sudden muscle contraction while muscle on stretch
    • Complete ruptures exhibit “Popeye” Sign
    • Younger athletes will usually require surgery, older adults may be fine with out